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COMMENTS FROM PREVIOUS PISANO AWARDEES

Carla C. Keirns
Department of History and Sociology of Science
University of Pennsylvania

I spent July and August 1998 in residence at the NIH History Office/DeWitt Stetten Museum of Medical Research tracing the groups who have studied asthma at the NIH in order to enrich my dissertation on the history of asthma in the United States.

Initial contacts with Sheldon Cohen, a senior NIH scientist who had worked on asthma at the institutes were important for his knowledge of the important laboratories, his organizational knowledge and personal connections with staff, and his own thoughts on NIH asthma research. Interviews with many current and former NIH staff members and fellows--as well as study of annual reports from NIAID, NHLBI, NIEHS, and NIMH--were important for elucidating what occurred in Bethesda laboratories, who the NIH groups collaborated with elsewhere, but perhaps most importantly, in clarifying the structure of the fields of asthma allergy, immunology, and pulmonology.

NIH is an important site for postdoctoral training, and many researchers who have trained and worked in other parts of the U.S. or the world did their postdoctoral work at NIH. The NIH History Office maintains a collection of the annual publication, Scientific Directory and Annual Bibliography , and also NIH telephone books back through the 1950s, which allow reconstruction of an individual scientist's laboratory affiliation and close colleagues as well as locating laboratories physically on campus as this changed over time.

The NIH atmosphere shapes the subsequent thinking of its “alumni” about research, best practices, and organizational structure. That training period also introduces many future leaders of the field to each other early in their careers -- fostering future collaborations and professional relationships. So while it was important to learn what work was being done at NIH itself, the most important findings of the project were probably in clarifying relationships between researchers elsewhere--relationships which began at NIH.

My dissertation project traces the twentieth-century transformation of hemophilia from an untreatable bleeding disorder into a chronic, manageable disease in the United States. Hemophilia's transformation has its roots in how expert knowledge about this bleeding disorder has evolved in biomedical research and treatment settings since the 1920s and '30s. It wasn't long, however, before “bleeder” patients, their families, and other lay-persons were interpreting medical and scientific understandings of hemophilia in their own transformative ways. Since World War II, expert knowledge and the experimental, diagnostic, and therapeutic technologies which accompany such knowledge have increasingly shaped the hemophiliac's interactions with the world, for both good and ill. This history of the scientific and clinical experiences of hemophilia is situated alongside of the human experience of this disease in a way that highlights the question of how -- by virtue of its “manageability” -- this seemingly “rare” disease has disproportionately impacted more recent developments in the areas of healthcare delivery, patient activism, the blood supply, and public and professional responses to epidemic diseases such as hepatitis and AIDS in the United States. In short, this dissertation examines how hemophilia evolved from being a relatively obscure health matter among a few “bleeder” patients and their physicians into a scientific and medical problem, a social and political issue, and a moral and cultural concern in American society-at-large.

The evolution of my research project has benefited a great deal from my exposure to the National Institutes of Health through the John J. Pisano Travel Grant. As a Pisano grantee, I found the NIH to be an unique resource for studying a variety of scientific, therapeutic, and social issues surrounding American biomedical research since World War II. My initial research plan was to investigate the on-site activities of both the National Heart, Lung, and Blood Institute (NHLBI) and the NIH's Clinical Center and to utilize my findings as a frame for understanding the scientific and therapeutic context surrounding hemophilia-related research over the past five decades. Through interviews with NIH scientists, I soon found that hemophilia-related research extended well beyond work at the NHLBI and Clinical Center. Hemophilia-related problems were, for instance, an important aspect of NIH intramural research on hepatitis and viral inactivation methods in the National Institute of Diabetes and Digestive and Kidney Diseases.

The scientists and staff at the NIH proved to be crucial resources for me. They were all helpful in relating firsthand experience of NIH research. But more importantly, many of these individuals were interested in the history of work at the NIH and how this work impacted society-at-large. These were sophisticated people, many of whom had their own developed ways of understanding the history of biomedical research in the United States and the central role of the NIH within that history. In my time as a Pisano grantee, I also found the NIH Campus to be a productive place to work. The NIH libraries and Historical Office have a variety of source material on hand, and the National Library of Medicine sits conveniently on the edge of the campus. My research at the NIH also produced leads which took me off-campus to nearby sites of interest. In my case, I visited the Food and Drug Administration and the Holland Laboratories of the American Red Cross to conduct interviews and search out other source material. The National Archives are also located nearby, and are a significant resource for historians working in the history of American medicine and science.

The NIH has not been a traditional stop for historians working on twentieth-century biomedicine (largely because it does not maintain a significant archive). Based on my experience however, this is a shame. I was able to utilize my visits to the NIH in ways that clearly enhanced my research on the recent history of hemophilia. Most notably, I was able to gain significant expert advice on issues of scientific and clinical relevance to this history that were not accessible from the literature and archives alone.

My dissertation has focused on the individual and organizational proposals for training models in clinical training during the first half of this century leading up to the traditional, scientist-practitioner model of clinical training which exists today. This scientist-practitioner model has widely been called the Boulder model because the idea emerged from the annual conference held by the American Psychological Association (APA) and funded by the National Institute of Mental Health (NIMH), held in Boulder, Colorado in 1949.

During the early decades of this century clinical psychology was a budding profession, and clinical psychologists worked predominantly as mental/intelligence testers (in child guidance clinics, schools, and during World War I, testing officers and new recruits). Psychologists always had to work under the supervision of psychiatrists, however, and were thought of as “mere technicians”, which led to a low professional status vis-à-vis other mental health providers.

Between 1917-1945 several professional psychological organizations were established to promote this status, to the chagrin of psychiatrists, who felt their territory was being invaded by unqualified (i.e., non-medical) psychologists, as well as of academic psychologists, who felt their hegemony was threatened by psychologists with more applied interests.

After World War II, the overwhelming number of psychological casualties required that clinical psychologists join forces with psychiatrists and other mental health providers in the treatment of neuroses. No formal training for clinical psychologists existed at the time, however. As a result, in 1946 the Veterans Administration (VA) and, shortly afterwards, the NIMH, actively began to request that APA create clinical doctoral programs which would train individuals who could help treat the war casualties. In response to the VA's and the NIMH's requests (and significant funding toward these programs), APA established a Committee on Graduate and Professional Training that was in charge of the accreditation of clinical psychology Ph.D. programs throughout the nation and directly paved the way for the soon-to-be Boulder model.

I applied for a Pisano travel grant to help fund the largest section of my dissertation which involves the relationship of the VA and the NIMH and the APA in the development of these scientist-practitioner Ph.D. programs in clinical psychology. Washington, D.C. holds the greatest number of resources able to document this relationship. The Pisano travel grant allowed me to spend three weeks in D.C. where I was able to visit the Library of Congress (repository of the American Psychological Association papers), the National Archives (repository of the NIH, the USPHS, and the ADAMHA papers), the National Library of Medicine, the American Psychological Association archives, and the American Psychiatric Association archives.

My goal during these three weeks was to locate primary and secondary material which would allow me to learn and write about various events: the National Mental Health Act of 1946; the establishment of the VA's Clinical Psychology Section; the establishment (within the USPHS) of the NIMH (from the formation of its Professional Services, Publications and Reports, and Biometrics divisions, to the three extramural branches of Research, Community Services, and Training, and its intramural research program on drug addiction); and the impact that both governmental agencies' funding had on the development of the scientist-practitioner model of training in clinical psychology.

In sum, I attempted to show how the scientist-practitioner model of training in clinical psychology was the product of a number of historical factors: the effects that World War I and II had on the budding profession, the boundary and professionalization issues that clinical and other applied psychologists faced vis-à-vis other mental health practitioners, the conflicting missions of the various clinical associations and APA, as well as the changing mission of APA itself under external, governmental directives as well as its own internal, divisional pressures. Overall, I tried to reconstruct the history of the Boulder model so that we can better understand how it has dominated the field of clinical psychology for over 50 years, so much so that its effects are still felt today.